Elsevier

Respiratory Medicine

Volume 110, January 2016, Pages 73-78
Respiratory Medicine

Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome

https://doi.org/10.1016/j.rmed.2015.11.010Get rights and content
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Highlights

  • Women are older, more obese and have poorer arterial blood gases than men when they are prescribed LTMV because of OHS.

  • Treatment in women is more often initiated in a non-elective situation than in men.

  • The prevalence of patients in Sweden with OHS treated with LTMV is steadily increasing.

Abstract

Background and objectives

Obesity hypoventilation syndrome (OHS) is often diagnosed late. The aim of this study was to analyse gender differences at initiation of long-term mechanical ventilation (LTMV) in patients with (OHS), to analyse gender differences in treatment effect and to study how the prescription of LTMV due to OHS has changed over time.

Methods

Data on patients on LTMV due to OHS between 1996 and 2014 were obtained from Swedevox, a nationwide health quality registry of patients on LTMV in Sweden.

Results

When starting LTMV, women were generally older (age 64.4 ± 11.2 vs. 60.1 ± 12.1 years, p < 0.001), more obese (BMI 43.0 ± 8.2 vs. 41.5 ± 7.9 kg/m2, p < 0.001), more hypoxic (PaO2 7.6 ± 1.5 vs. 7.9 ± 1.6 kPa, p = 0.001), had more hypercapnia (PaCO2 7.2 ± 1.3 vs. 6.9 ± 1.3 kPa, p = 0.001), had higher base excess (6.9 ± 4.1 vs. 5.8 ± 4.7 kPa, p < 0.001) and more frequently started LTMV in a non-elective situation (43.2% vs. 37.5%, p = 0.026) than men. Improvement of arterial blood gas values or in age-adjusted mortality at one-year follow-up did not differ. During the study period, the age of patients at the initiation of LTMV rose by 3.4 years/decade (P = 0.001) in women and with 1.9 years/decade (P = 0.048) in men but there were no significant changes in BMI (P = 0.425).

Conclusions

Diagnosis of OHS is more delayed in women and as a consequence the disease is more advanced when diagnosed. In spite of this, there is no gender difference in survival rate in patients with OHS treated with LTMV. More and older patients with OHS nowadays gain access to LTMV.

Keywords

Body mass index
Gender differences
Long-term mechanical ventilation
Obesity hypoventilation syndrome

Abbreviations

ALS
amyotrophic lateral sclerosis
AHI
apnea-hypopnea index
BE
base excess
BMI
body mass index
COPD
chronic obstructive pulmonary disease
CPAP
continuous positive airway pressure
ESS
epworth sleepiness scale
FEV1
forced vital capacity in 1 s
LTMV
long-term mechanical ventilation
OSA
obstructive sleep apnoea
OHS
obesity hypoventilation syndrome
VC
vital capacity

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